This is an application for a Mentored Research Scientist Development Award (K01) submitted by Dr. Adam Spira, a clinical psychologist conducting research on adverse outcomes of late-life sleep disturbances as an assistant professor at the Johns Hopkins Bloomberg School of Public Health. Poor sleep quality and sleep-disordered breathing (SDB) are highly prevalent in older adults, but remarkably little is known about the extent to which they predict the key geriatric health outcomes of functional decline and nursing home placement. During the K Award, Dr. Spira will determine this association in older men and women enrolled in two large cohort studies of aging with outstanding measures of sleep and function: the Osteoporotic Fractures in Men Study (MrOS) and the Study of Osteoporotic Fractures (SOF). In addition to self-report measures of sleep quality and SDB, 4,532 participants in MrOS and SOF completed actigraphy (a means of measuring sleep by recording movement), and 3,006 completed ambulatory polysomnography at baseline and returned for follow-up 3.5 to 5 years later. Further, participants in these cohorts completed self-report and performance-based measures of function at baseline and at follow-up. Thus, Dr. Spira is ideally poised to determine the extent to which late-life sleep disturbances predict functional decline and nursing home placement. In addition, he will investigate several candidate mechanisms linking sleep disturbances to functional decline and nursing home placement, including use of sedative-hypnotic medications; cognitive decline; medical co-morbidities; and inflammation. Results could help establish sleep disturbances as risk factors for disability in older adults, leading to screening for sleep disturbances to identify elders at risk for functional decline. Because sleep disturbances can be treated, findings could translate into randomized trials of interventions for disturbed sleep with the long-term goal of preventing disability. Dr. Spira has formed an outstanding interdisciplinary mentorship team led by George Rebok, PhD, with Co-Mentors Naresh Punjabi, MD, PhD, Kristine Yaffe, MD, and Kenneth Covinsky, MD, MPH. To enhance his career development, Dr. Spira will complete a rich series of training activities, including coursework in advanced analytic methods and design and conduct of clinical trials, hands-on instruction in actigraphic and polysomnographic sleep assessment, directed readings and tutorials with his mentors, and didactics with high relevance to the proposed studies. The K01 will provide the protected research time, mentorship, and training activities Dr. Spira requires achieving independence as an investigator. PUBLIC HEALTH RELEVANCE: Poor sleep quality and sleep-disordered breathing are very common among elders, yet we know little about the extent to which they predict, and perhaps cause, functional decline and nursing home placement. The proposed research would determine these associations and the mechanisms linking disturbed sleep to these outcomes. Because effective sleep interventions exist, findings could establish sleep disturbances as modifiable risk factors for disability, and raise the possibility that sleep interventions might prevent disability.